Drug Administration & IV Fluids in the Birth Plan

By: Aunt Doula (10/13/2022)

One of the very first things that you will be told is happening upon admission is an IV line. In practice this is generally a very good idea to have a line available for emergencies, however unless you are having difficulty keeping fluids down and your intake up, there should be a clear reason given to you for whatever you are being given, including saline. Being overloaded with fluids can be extremely uncomfortable, lead to cervical swelling that delays labor, and make those already frequent trips to the bathroom practically constant!

It is in your best interest to know what you want in regards to an IV because it gives you much more freedom to move in labor if you aren't connected to an IV pole. You will use the bathroom more often if you don't have to move the pole with you, and it will be more encouraging to not feel like you must remain confined to bed.

Now saline fluids is one thing, but prescription drugs are another. In the course of your labor and delivery stay, you may be given a host of things that are "standard of care" and will be set up to go through your IV line for administration into your body, and they may not tell you if you don't ask what it is, or set the condition in your birth plan that you want to know. Common examples include

• Antibiotics - If your water has been broken for 12-24 hours, or if you develop a fever regardless of no signs of infection. If you were positive for Group B Strep you will also be given antibiotics automatically, often without discussion.

• Pitocin not related to induction (see Active vs Expectant Management in the Third Stage)

• Anti-nausea medications that can impair your memory instead of non-impairing options

These are just a few examples of things that may unknowingly be administered to you if you do not have it stated in your birth plan that you want to be informed of each medication and its purpose. This is obviously overruled in emergency situations when the medical necessity and choices of the doctors and nurses takes priority

When facing an IV on admittance into the hospital, you have multiple choices.

• IV placed, capped off known as a "Saline Lock" and you will remain unhooked from a pole unless a medication or fluids are ordered and you consent to their administration.

• IV placed, hooked up to continuous drip of fluids (Know the reason behind your continuous drip and what your parameters are for being disconnected)

• IV Declined - Hospitals will usually not allow this choice, and if you are strongly against having an IV placed even with a saline lock, I would highly recommend you call ahead and ensure your preference is in your chart and understood by the floor staff upon admission so this isn't a battle you have to fight when you arrive!

During the course of a stay on a labor and delivery ward, an IV may be considered an obvious choice and that is relatively true. It makes sense that accepting an IV is a normal part of being in the hospital. Where you want to ensure your choices are being heard is in regard to what that access allows staff to do without always informing you. The primary reason to have this in your birth plan is to ensure that you will be informed about whatever you are receiving, from saline to opioids - it is important to stay aware of medications, their purpose, their possible side effects and how long they are going to require you to stay connected to the IV pole. Indicate if you wish to be awoken before drugs are administered if you are sleeping.

By placing the Drug and Administration choice on your birth plan, you are making it clear that you want all information to go through you before anything goes into your veins. Just because they have access doesn't mean they should have blanket permission to administer anything into you without your informed consent. It would be a statement along the lines of "Do Not Administer ANY Substances without Informed Consent - Always Wake for Consent" next to your choice of IV option above.